Five key change objectives guide the realization of the long-term vision. In the first phase of this work (over one year, starting in August 2015), task teams (comprised of health and WASH specialists) will address the change objectives and refine tasks and deliverables to demonstrate immediate progress and establish the foundation for longer-term change. The four task teams will focus on: Advocacy, Action and Leadership; Monitoring; Evidence and Operational Research; and Policies, Standards and Facility-based Improvements. Updates from the task teams will be shared on this website.
Building infrastructure and engaging in behavior change are not enough. Facilities must have management and quality improvement structures to identify and address critical risks, and to ensure processes exist to support operation and maintenance. WASH and health actors should support systems to be in place so that health facility users and staff can advocate to government and duty bearers to ensure access to WASH and safe, quality health care delivery at health facilities. WASH in health care facilities should be a key component of facility risk-based assessments, audits and quality of care assessments.
WASH Expertise: Utilise lessons learned and expertise from WASH risk-based approaches, such as Water Safety Plans and Sanitation Safety Planning, and draw on these lessons to include critical elements of these tools in similar assessments conducted in health care settings. Draw on experience from rights-based WASH activities to support health facility users and staff to advocate for improvements, maintenance and on-going investments in WASH in health care facilities.
Health expertise: Ensure that existing health facility audit tools and assessments, particularly those related to financing for facilities and quality of care, include WASH in health care facilities as a core element and have mechanisms to act and respond to the WASH needs as required
Existing and newly generated evidence should be analysed and developed and used as a catalyst for advocacy, for driving investments and supporting evidence based action and improvements at the facility level. Particular attention should be given to generating operational research on how to most effectively and sustainably improve WASH services and practices in health care facilities. This will inform effective implementation, scale up and further understand what drives and sustains change.
WASH Expertise: Collaboratively undertake operational research of how to most effectively improve WASH services and practices within larger health systems structures. Develop costing tools to assess trade-offs of various WASH options. Support implementation of locally appropriate and environmentally sound technologies as well as develop and test new ones where necessary.
Health expertise: Draw on experience and evidence in areas relating quality improvements, health systems resilience and strengthening, burden of disease, cost effectiveness and cost benefits of effective solutions and, demand and supply side health service delivery improvements.
The WHO/UNICEF Joint Monitoring Program on Drinking Water and Sanitation is developing a set of core and extended indicators for assessing access to WASH in health care facilities. These should be incorporated into all relevant WASH and Health sector programmes and accountability mechanisms. This includes HMIS, the monitoring frameworks under development for the Sustainable Development Goals, accountability frameworks for Universal Health Coverage and other relevant national WASH and health monitoring mechanisms.
WASH Expertise: Ensure all district and city-wide WASH activities include core and extended indicators on WASH in health care facilities. Building on existing WASH monitoring expertise, work with health actors to support quality and reliable monitoring of WASH in health care facilities.
Health expertise: Embed the core and extended indicators into health system accountability and monitoring frameworks including those on Universal Health Coverage, quality of care for maternal and newborn health, national health system readiness surveys, and outbreak preparedness, response and resilience frameworks.
It is important to ensure that all infrastructure and behavioural WASH-related work undertaken in health care facilities aligns with the standards as set out in WHO’s Essential Environmental Health Standards in Health Care. These standards should be adapted for each context and type of health care facility. All actors should support adherence to and implementation of national standards if they exist, or work with health authorities to develop, update and implement them if they do not.
WASH Expertise: WASH actors should ensure that all WASH services provided at health care facilities meet WHO or national standards.
Health expertise: All existing quality of care and infection prevention control policies and standards and related training materials should reflect the standards.
The global WASH and health community must advocate for action to improve access to and investment in WASH in health care facilities. This includes to embedding WASH in health care facilities as a key component of quality Universal Health Coverage, maternal and newborn health targets, infection prevention and control activities and, outbreak prevention and response.
WASH Expertise: WASH advocacy efforts should broaden to engage with health partnerships, institutions and movements, and to encourage cross- sectoral collaboration within development agencies and partners.
Health expertise: Health advocacy efforts should ensure that all relevant health priorities and activities, particularly those relating to quality Universal Health Coverage, include targets and plans to ensure access to and behaviours related to WASH in health care facilities.